2Institute of Cardiovascular and Medical Sciences, School of Medicine, University of Glasgow, Glasgow, UK

3Department of Clinical Pharmacology, Glasgow Royal Infirmary

gerard.mckay{at}ggc.scot.nhs.uk

Treat the patient not the HbA1c

Medical providers must prepare for two important demographic changes—the increase in life expectancy and the fact that we are getting fatter. As a consequence, the prevalence of diabetes is rising across the age spectrum, including among older people. People over the age of 65 years with diabetes experience higher rates of microvascular and macrovascular complications, which leads to increased hospital admissions, healthcare expenditure, and requirements for social care. Treating older people with diabetes is challenging, not least because the risks of hypoglycaemia and associated complications from overly aggressive treatment are also increased.

In recognition of this treatment paradox, the American Diabetes Association (ADA) and the American Geriatrics Society published a joint statement providing guidance for clinicians.1 Previous American Geriatrics Society guidelines recommended treatment aimed at achieving a glycated haemoglobin (HbA1c) of less than 53 mmol/mol (<7%) for all adults, regardless of age.2 The new guidance, however, emphasises the need to tailor treatment in older people. This echoes statements from the British Geriatrics Society and the European Diabetes Working Party for Older People, which both supported this approach,34 recommending that hypoglycaemia, ability to self manage, cognitive status, comorbidities, and life expectancy are taken into account when making decisions on treatment.

The new …

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